How to Cope with “Brain Fog” When You’re Chronically Ill

Cognitive dysfunction is often a distressing feature of chronic pain and illness

People who are chronically ill (which includes chronic pain) often experience cognitive difficulties. Sometimes this is referred to as “brain fog,” which is defined as a lack of mental clarity due to an inability to focus or remember things.

You may have trouble concentrating on the task at hand. You may have trouble with reading comprehension and find yourself going over the same paragraph several times (this can happen to me). You may have trouble remembering things—big and small (from where you left your cell phone, to what you watched on TV the night before, to the task you decided to undertake just moments before).

What follows are six strategies I’ve developed after almost 18 years of chronic illness to help me cope with cognitive dysfunction. I’m not a therapist, so my suggestions are based on my personal experience.

I’m fortunate that, at times, my mind is sharp enough to be able to write (and remember where I put things). That said, the strategies and suggestions that follow would be helpful for those of you whose cognitive dysfunction is a permanent feature (or side-effect as I like to call it) of your chronic illness.

If your chronic illness causes brain fog, it’s not your fault, just as being sick or in pain in the first place is not your fault. Health problems are part and parcel of the human condition. Everyone faces pain and illness at some point during his or her life. I still get sad that chronic illness has so drastically limited what I can do and that I often experience cognitive dysfunction, especially the inability to concentrate and focus on things. But I’ve learned not to blame myself. Being sad and engaging in self-blame are different mental responses to chronic illness and its consequences. Sadness can (and hopefully does) give rise to self-compassion. Self-blame cannot.

#2: Start keeping a record of when your cognitive difficulties are the worse.

See if you can detect any patterns related to when cognitive dysfunction kicks in or becomes more intense. Is it at certain times of day? Is it after engaging in certain activities? Is it when you’re experiencing a flare in symptoms? (On this latter issue, see my article “7 Ways to Survive a Flare When You’re Chronically Ill”).

So, start paying attention to whether there are triggers for your brain fog. For me, one trigger is stress. Another is having overdone it the day before. I know that if it’s been a stressful day or if I’ve overdone it (which almost always sets off a flare), I have to find something else to do other than use my brain.

It’s been extremely helpful for me to learn what triggers cognitive difficulties for me. First, learning this has brought some predictability to my life; and second, it’s kept me from becoming frustrated about not being able to write or do other tasks that require concentration. I don’t get frustrated because, usually, I can point to a cause for my decreased ability to concentrate or write.

In other words, I can say to myself: “Look, you know that since you overdid it yesterday, this is not a day you’ll be able to write. That’s okay.” Pointing to a cause like this also reassures me that my cognitive faculties will improve when the stress dies down or when the flare dies down.

(Note: I recognize that, at times, cognitive difficulties arise for no rhyme or reason. When this happens to me I have no choice but to stop, for example, working on these articles. I’m not happy about it, but I can’t force my mind to be clear when it’s foggy.)

#3: If you’re experiencing brain fog, don’t try to memorize things or figure them out in your head. Instead, write them down.

If I need to use my brain at a time when it’s not functioning well, my best friend becomes pen and paper. When I can’t think straight (as the expression goes), it’s extremely helpful to keep track of things in writing. (Some of you may prefer to use a computer for this and that’s fine.) Writing down my thoughts instead of trying to memorize things or figure out a problem in my head actually improves my cognitive abilities. I think it’s because it calms my mind and this enables me to see things more clearly.

For example, if I have an upcoming doctor’s appointment (I’ve recently been seeing an orthopedist about knee and rotator cuff pain due to osteoarthritis) and I can’t concentrate enough to remember what I want to bring up, I make a list. Even though, as I begin the list, I can’t remember what I was intending to raise at the appointment, as soon as I remember one thing and write it down, I’m likely to remember the rest.

#4: Write down “pros and cons” before making decisions.

Years ago (meaning, before I got sick!) I served for several years as the dean of students at U.C. Davis’ law school. Students frequently sought my advice when they couldn’t make a decision, whether it be a relatively minor one (“should I stay in this class or drop it?”) or a major one (“should I stay in school or drop out?”).

I learned that the best way to help a student make a decision was to take a piece of paper, draw a line down the middle, and on one side list the “pros” of deciding, for example, to stay in school; and, on the other side, list the “cons” of doing so. Having students consider the issue this way almost always made it clear to them what the best decision was.

I use this same technique to cope with brain fog. If I can’t think clearly enough to make a decision, I pick up pen and paper, draw that vertical line down the middle, and start listing “pros” and “cons.”

#5: Break down big tasks into a series of tiny ones.

If you have something to do that’s going to require a lot of concentration, don’t attempt to do it all at once. Make a list of what’s involved and then spread the task out over as long a time as you can—even weeks if that’s possible. And if, on a given day, your brain fog is too intense to perform the part of the task that you allocated for that day, that’s fine. Just move it to the next day. Even if you have to keep moving things forward, eventually you’ll have a day when your brain is clear enough that you can make up for lost days by doing more than one part of the task on that day.

#6: Find a game that’s fun and gently challenges your mind.

I think of this as exercising my brain in order to help keep my cognitive abilities as strong as possible. For the first time ever, I’ve started playing a game on my smart phone. It’s called Wordscapes. I’m shown a set of letters and have to combine them to make words that then fill in crossword squares. Sometimes the letters are easy for me and sometimes they’re a real challenge. (One reason I like this game is that there’s no “timer,” meaning that I can go as slowly as I want, so it’s not stressful to play.)

If my cognitive difficulties are intense on a given day, I can’t play Wordscapes…and I accept that. I think, however, that playing it is helping to reduce the frequency and intensity of episodes of cognitive dysfunction. I suppose this comes under that heading of “use it or lose it” that I’m constantly hearing in regard to bodily exercise. (Now there’s a source of stress for me—always being told that I need to engage in strenuous exercise, which is impossible given my illness.) But I can gently exercise my brain!

I think of games such as Wordscapes, Scrabble, Boggle, and even jigsaw puzzles as “brain food.” Incorporating one or more of them into your life just might reduce the frequency and intensity of your brain fog.

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I hope these strategies and suggestions have been helpful. From my foggy brain to yours, I send warmest good wishes.

Thank you Toni for the very helpful suggestions. I hadn’t considered finding a triggers for my brain fog such as stress and overdoing it. I have found a link between gut issues (SIBO) and my brain fog. When I took antibiotics to kill bad SIBO bacteria I could be articulate in a conversation and think! I have also noticed that lack of sleep contributes to brain fog for me.

I love your practical approach to it as well as your reminder to be compassionate towards ourselves and not be critical of ourselves for having brain fog.

One of which I already use: I started graduate school two years ago and struggled so hard with brain fog for the first two classes that I was ready to give up on the whole idea. My caregiver actually started noticing that when I tried to study during the day, I got more frustrated and was not able to concentrate. She suggested I try studying when I woke up in the middle of the night unable to go back to sleep. I did and it worked! Now I spend 2-5 hours a night reading and making notes or typing my papers. It's not always a solution, especially if I'm in a lot of pain, but I'm able to finish my course assignments and have a 3.82 GPA!
Next up: working on the "don't beat myself up" tip....thanks, Toni!

Toni, thank you for this post. This comes at a time when I most needed it. My brain fog is getting worse. With chronic pain, getting closer to menopause, etc., I have had such a struggle with this. I haven't been to kind with myself regarding this. I realize it probably stems from shame, thinking I did something wrong to have brain fog and forgetting things.

Recently, in an attempt to keep my mind occupied and happy/challenged, I started playing chess and it has struck me like a ton of bricks just how badly my cognitive abilities are impaired at times. My ability to solve tactical puzzles differs drastically from one day to the next.

Having both a connective tissue disorder as well as Bipolar on top of that makes it doubly hard. I often feel that if it was just one or the other I may be able to function more productively and "sainly" but between the cognitive deficit from chronic pain and fatigue as well as the Bipolar tendency's being exacerbated by that, I just don't have any trust in my actions and/or thought processes.

I too had felt like I had done something wrong, but I really had so I started asking God to forgive me of the things I had done wrong. Making amends doesn't come easy for me. After I ask God to forgive me then I had to forgive myself for being imperfect, afterall I was a perfectionist. I now have learned to forgive myself because God can forgive us but we too have too accept we are human and forgive ourselves and try and make amends wherever or whenever possible. You definitely are not alone. I hope this helps.

I needed this reminder today! After almost 11 years living with ongoing cardiac symptoms, I can sometimes convince myself that I have the "system" down pat by now (e.g. a calendar carefully planned with A. 1-outing days or B. 2-outing days, or (rarely!) C. 3-outing days - with naps or rest carefully planned before each outing, and after each outing to recuperate. But every so often, I get excited about some invitation or event that sounds so irresistible that I forget about my A, B and C plans entirely and I'm hit with crushing fatigue and a whopping case of brain fog.

That's when I need to review your six tips again! Thanks for this, Toni.

Thank you, Toni, for another great post! Keeping lists, a journal and a comprehensive calendar are invaluable to me. I try to complete one project at a time, when possible, because I've found that multi-tasking overwhelms and confuses me. With just my husband and me we try to keep our home orderly: toss the unneeded and keep like items together. When I need to remember something I often leave an item in sight as a clue. Most important to me is recognizing when I'm struggling mentally, and simply saying to myself, "Not now, later." Trying to plow through it is usually frustrating and disheartening to me.
I'm so grateful to you for your posts and your audiobooks that I continually turn to during the dark periods, and they always help!